Anesthesia and analgesia
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Anesthesia and analgesia · Feb 2013
Intracranial hemorrhage requiring surgery in neurosurgical patients given ketorolac: a case-control study within a cohort (2001-2010).
Ketorolac tromethamine (ketorolac) is a nonsedating drug with potent analgesic and moderate anti-inflammatory activity, which does not increase the sedation level. The safety of ketorolac with respect to risk of bleeding has been demonstrated in large numbers of patients undergoing general surgery, yet comparable safety data for neurosurgical patients are lacking. We studied the risk of symptomatic bleeding requiring surgery in patients undergoing elective neurosurgical procedures who received ketorolac as analgesic therapy. ⋯ Although the adjusted estimate for risk of symptomatic bleeding requiring surgery and ketorolac use is very close to the null effect, it may be not reproducible, and the width of the confidence interval is not conclusive evidence of the safety of ketorolac after elective neurosurgical procedures.
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Anesthesia and analgesia · Feb 2013
The effect of OPRM1 and COMT genotypes on the analgesic response to intravenous fentanyl labor analgesia.
IV fentanyl is used as a labor analgesic; however, few studies have reported the effects of IV fentanyl for early labor analgesia. We evaluated the analgesic response to IV fentanyl according to the combined effect of the single-nucleotide polymorphisms rs1799971 (c.118A/G, p. 40Asn/Asp) of the µ-opioid receptor gene (OPRM1) and rs4680 (c.472G/A, p.158Val/Met) of the catechol-O-methyltransferase (COMT) gene in women requesting labor analgesia. ⋯ This study was underpowered to draw firm conclusions on the influence of OPRM1 and COMT genotypes on labor analgesia with IV fentanyl. Further larger studies are needed to evaluate whether genotyping COMT alone or in combination with OPRM1 may have potentially useful clinical implications, such as not offering IV fentanyl in early labor to women who will most likely not benefit from it.
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Anesthesia and analgesia · Feb 2013
Comparative StudyBispectral index dynamics during propofol hypnosis is similar in red-haired and dark-haired subjects.
We have previously shown that red hair is associated with increased desflurane requirement for immobility, compared with dark hair. The effect of red hair on IV anesthetic requirement remains unknown. We tested the hypothesis that the propofol concentration in the effect site associated with half maximal electroencephalogram response, Ce50, is at least 50% higher in subjects with red hair. ⋯ Red hair phenotype does not affect the pharmacokinetics or pharmacodynamics of propofol.
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Anesthesia and analgesia · Feb 2013
Incidence, predictors, and outcomes of perioperative stroke in noncarotid major vascular surgery.
Perioperative stroke is a potentially catastrophic complication of surgery. Patients undergoing vascular surgery suffer from systemic atherosclerosis and are expected to be at increased risk for this complication. We studied the incidence, predictors, and outcomes of perioperative stroke after noncarotid major vascular surgery using the American College of Surgeons National Quality Improvement Program database. ⋯ Perioperative stroke is an important source of morbidity and mortality, as reflected by significant increases in median surgical length of stay and all-cause 30-day mortality. The independent predictors of stroke that we have identified in this population are not readily modifiable and the majority of strokes occurred after postoperative day 1. Additional studies are required to identify potentially modifiable intraoperative or postoperative risk factors of perioperative stroke.
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Anesthesia and analgesia · Feb 2013
Case ReportsCase report: Perioperative pacemaker-mediated tachycardia in the patient with a dual chamber implantable cardioverter-defibrillator.
Patients with cardiac implantable electronic devices are at additional risk for arrhythmias while undergoing surgical procedures. In this case report, we present a patient with a dual chamber implantable cardioverter-defibrillator who developed intraoperative pacemaker-mediated tachycardia causing significant hemodynamic instability. Management of this arrhythmia can be particularly challenging, because standard application of a magnet does not affect the pacing functions of an implantable cardioverter-defibrillator. Awareness by the anesthesiologist and timely coordination with the cardiac electrophysiology team helped to optimize care for this patient.